The latest Access to Medicine Index, which ranks the top 20 pharmaceutical companies on their efforts to improve access to medicine in developing countries, finds that the industry is doing more than it was two years ago, with GlaxoSmithKline still outperforming its peers, but an expanding group of leaders closing the gap.

The Index, published Wednesday, found that Johnson & Johnson was one of the most dramatic risers, climbing from the middle of the field in 9th position in the 2010 Index to 2nd this year, closely behind GlaxoSmithKline. It is one of two newcomers to the top three. Its rise is due largely to its consolidation of its access activities under one business unit, which has resulted in a more strategic and integrated approach, and to its acquisition of vaccine maker Crucell, which has increased the relevance of its research and development investments. It has also disclosed more overall about its access activities.

"This year's Index shows that companies are becoming more organised internally in their approach to access to medicine and that those who do this best tend to perform well across the other aspects we measure. The leaders are really raising the bar," said Wim Leereveld, founder and CEO of the Access to Medicine Index. "It's also clear that companies that do not continue to step up their efforts tend to be overtaken by their peers."

The Access to Medicine Index is an independent initiative that provides insight into what the world's leading pharmaceutical companies are doing for the millions of people in developing countries who do not have reliable access to safe, effective and affordable medicines, vaccines and other health-related technologies. It is published every two years.

It scores companies on their commitments, performance, innovation and level of transparency across seven areas of activity considered key to improving access to medicine. The companies are graded on more than 100 factors covering these areas, including whether they are developing new drugs for neglected diseases, to what extent they facilitate or resist efforts to create generic versions of their drugs, and how they approach pricing in developing countries. Lobbying activities, marketing ethics and product donations and other philanthropic activities are also tracked.

Ranking highlights: Who is doing the most?

GlaxoSmithKline remains at the top of the Index with a marginal improvement in performance since 2010, and this year, Johnson & Johnson and Sanofi, both new to the top three, follow closely in 2nd and 3rd positions respectively. The companies that rose in rank the most were Merck KGaA, followed by Johnson & Johnson, and then Bayer. AstraZeneca fell down the rankings most significantly, followed by Boehringer-Ingelheim, then Novartis and Roche. The bottom of the league is dominated by Japanese companies Takeda, Daiichi and Astellas.

Overall trends

Seventeen out of the 20 companies perform better than they did at the time of the last Index in 2010. At the top end, membership of the leading group has expanded from three to seven companies, and there is a smaller difference between the scores of the Index leaders than there was in 2010. Meanwhile, the gap has also narrowed between the bottom few companies and the top performers. This is notable given the fact that the Index set higher standards this year in many areas.

Companies are developing more products for more diseases that particularly affect the world's poor, and collaborating more in the process than they were two years ago. There is more target setting and some now devote as much as 20% of their pipeline to developing products that address the needs of the poor. For instance, Sanofi is adapting its leishmaniasis drug, which currently requires health workers to administer repeated injections, to develop a product that patients can apply to their skin at home. Meanwhile, Johnson & Johnson is collaborating to develop a simple portable rapid screening test for tuberculosis that doesn't need to be operated by a health professional, requires patients to simply cough into a breathalyser, and yields results within minutes.

In addition, more companies are using tiered pricing schemes to lower prices for certain countries or population groups within a country, and applying them to a broader range of products and in more countries.

However, there are still several areas where all companies could improve their approaches significantly. These include being more transparent about their lobbying practices, expanding their tiered pricing schemes, adapting packaging to local needs, making their drug donations more needs-based, and allowing their clinical trial data to be used to accelerate the approval of generic medicines in developing countries.

An area where current industry performance falls far short of Index expectations is transparency around the outsourcing of clinical trials to Contract Research Organisations (CROs). Companies often hire them to conduct clinical trials on their behalf in developing countries, but no company is publicly transparent about all the CROs they employ. Company accountability involves ensuring the wellbeing of trial participants through adequate due diligence in selecting these contractors, monitoring how they conduct the trials and willingness to enforce codes of conduct with disciplinary action. However, only four companies (Merck & Co., Sanofi, GlaxoSmithKline and Eisai) provided evidence that they use disciplinary measures to enforce codes of conduct with their CROs to ensure that trials of their products are conducted safely and ethically.

"Access to medicine is a multi-faceted challenge and therefore responsibility for improving it lies with a number of different actors, but the pharmaceutical industry has a critical role to play. While the Index shows it has made strides in many areas, companies that have sector-leading practices also show us there is more the industry can contribute," Leereveld said.

Notes:

The Access to Medicine Index is published by the Access to Medicine Foundation, a non-profit organisation based in the Netherlands that aims to advance access to medicine in developing countries by encouraging the pharmaceutical industry to accept a greater role in improving access to medicine in less developed countries. The Index methodology was developed, and is continually refined, in consultation with multiple stakeholders including the WHO, NGOs, governments and universities, as well as 30 institutional investors. The Index is funded by the Bill & Melinda Gates Foundation, the Dutch Ministry of Foreign Affairs, the UK Department for International Development and other charitable organisations.

The scoring and ranking of company performance for the 2012 Index was conducted by MSCI ESG Research, which provides environmental, social and governance ratings, screening, analysis, benchmarking and compliance tools to advisers, investment managers and asset owners worldwide.

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